Integrating data from multidisciplinary Management of Malignant Pleural Mesothelioma: a cohort study.

BACKGROUND: Malignant pleural mesothelioma (MPM) is a rare and aggressive malignancy that most commonly affects the pleural layers. MPM has a strong association with asbestos, mainly caused by exposure to its biopersistent fibers in at least 80% of cases. Individuals with a chronic exposure to asbestos might develop disease with a 20-40-year latency with few or no symptoms. Such has been the case in the Italian regions of Piedmont and Lombardy, where industrial production of materials laden with asbestos, mainly cements, has been responsible for the onset of a large epidemic. Since 2018, a multidisciplinary team at San Matteo hospital in Pavia has been collecting data on over 100 patients with MPM. The main goal of this project is to define and describe an integrated profile for each MPM case at diagnosis by using data mining and partition analysis. METHODS: Here we bring together exhaustive epidemiologic, histologic and radiologic data of 88 MPM patients that came to our observation and draw correlations with predictive and prognostic significance. RESULTS: The median overall survival (OS) was 15.6 months. Most patients presented with pleural effusion, irrespective of disease stage. Quite unexpectedly, no statistically significant association was demonstrated between OS and TNM disease stage at diagnosis. Although average OS is similar in male and female patients, partition analysis of data underlined a significant differential hierarchy of predictor categories based on patient gender. In females with no smoking history, full chemotherapeutic regimens are associated with better outcomes. Moreover, concerning second line treatments, vinorelbine emerged as the most advantageous choice for female patients, whereas in the male subgroup no statistically significant difference resulted between gemcitabine and vinorelbine. CONCLUSION: A multidisciplinary approach to MPM is mandatory to define better therapeutic approaches, personalize the management and improve patient outcomes.

Feasibility and safety of extended pleurectomy/decortication for malignant pleural mesothelioma. A single group experience.

Surgery is part of a multimodal therapeutic approach to malignant pleural mesothelioma (MPM) although its real beneficial effect is still controversial. The optimal precise sequence of treatments within the trimodality is unclear, and should be decided upon a multidisciplinary consensus for each individual patient. Here, we analyzed the perioperative data of 19 MPM patients who underwent extended pleurectomy/decortication (EPD) with curative intent. The mean age at diagnosis was 67 years; 11 males and eight females. Ten patients were diagnosed with MPM via medical thoracoscopy (MT), and nine via video-assisted thoracoscopic surgery (VATS). The vast majority of cases harbored epitheliod forms. We compared neoadjuvant chemotherapy (NCT) followed by surgery (11 cases) versus surgery followed by adjuvant chemotherapy (ACT, 8 cases) within a 3-year period. All patients had extended pleurectomy/decortication and none had an extended pneumonectomy. Analysis of survival curves suggested that the short-term outcomes are better with upfront EDP followed by ACT if compared to EDP preceded by NCT. Although limited, the data highlighted the safety and feasibility of EPD, with manageable postoperative complications and no major burden for the patients.

Determination of annual and seasonal daytime and nighttime trends of MODIS LST over Greece - climate change implications.

Climate change is one of the most challenging research topics during the last few decades, as temperature rise has already posed a significant impact on the earth's functions thus affecting all life of the planet. Land Surface Temperature (LST) is identified as a key variable in environmental and climate studies. The present study investigates the distribution of daytime and nighttime LST trends over Greece, a country in the Mediterranean area which is identified as one of the main "hot-spots" of climate change projections. Remotely sensed LST data were obtained from MODerate Resolution Imaging Spectroradiometer (MODIS) sensor in the form of 8-day composites of day and night values at a resolution of 1km for a 17-year period, i.e. from 2000 to 2017. Spatial aggregates of 10km×10km were computed and the annual and seasonal temporal trends were determined for each one of those sub-areas. Results showed that annual trends of daily LST in the majority of areas demonstrated decrease ranging from -1∗10-2°C to -1.3∗10-3°C, with some sporadic parts showing a slight increase. A totally different outcome is observed in the fate of night LST, with all areas over Greece demonstrating increasing annual trends ranging from 4.6∗10-5°C to 3.1∗10-3°C, with highest values in the South-East parts of the country. Seasonal trends in day and night LST showed the same pattern, i.e., a general decrease in the day LST and a definite increase in night. An interesting finding is the increase in winter LST trends observed both for day and night LST, indicating that the absolute minimum annual LST observed during winter in Greece increases. Our results also indicate that the annual diurnal LST range is decreasing.